M1T1 OMM Midterm Flashcards by Gregory Skedros

Before engaging in palpation, what should you ask/tell the patient?

Ask for permission to palpate. After receiving permission, inform the patient what you are going to do

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What are characteristics of deep fascia?

Partitions muscles into groups
Densely packed (thin and strong)
Most extensive
External investing and deep investing layers

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What vertebral level does the umbilicus approximate?

T10

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What vertebral level does the sternal angle approximate?

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Fascia is composed of ________ and ________ fibers and a ground substance composed of ________ and ________.

Collagen, elastin, thin gel, mineral salts (in bone)

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________ occurs when there is an increased frequency of action potentials (which can lead to tetany or maximal sustained contraction).

Frequency summation

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80% of healthy individuals have an alternating Zink fascial pattern. What is this pattern starting from the head?

OA: ease leftCT: ease rightTL: ease leftLS: ease right

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Which model was J. Gordon Zink a champion of?

Respiratory-circulatory model

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A ________ is a functional limit within the anatomical range that diminishes the normal physiological range.

Restrictive barrier

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What are the characteristics of an acute somatic dysfunction?

Pain: acute, severe, sharp
Vasculature: vasodilation and inflammation
Skin: warm, moist, red/inflamed
Tissues: edema, boggy
Musculature: increase in local tone (hypertonic) leading to contraction, spasm, or poor quality of motion
Viscera: minimal somatovisceral effects

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What is the definition of touch?

Physical contact involved in palpation

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What are the spaces between muscle fibers filled with and what does it contain?

Sarcoplasm. K, Mg, PO4, enzymes, lots of mitochondria, sarcoplasmic reticulum

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Define elasticity and plasticity.

Elasticity: ability to resume original shape after deformationPlasticity: ability to retain shape after deformation

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What happens when a muscle is at rest?

The muscle receives impulses from the spinal cord so a certain amount of tautness remains in the muscle at all times

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How far do muscle fibers span and how many neurons innervate one fiber?

The entire length of the muscle and only 1 neuron per fiber

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Small motor units are recruited initially followed by larger motor units (if necessary) is a process known as ________.

Multiple fiber summation

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What adds new sarcomeres to the ends of muscles?

Stretching

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What is the term for “bow-legged”?

Genu varus

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Myofascial release, myofascial unwinding, and ligamentous articular strain are all ________ techniques.

Indirect

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If loss of signal from neurons causes atrophy in muscle, what will eventually happen over time if there is no recovery?

Replacement by fibrous and fatty tissue which contracts over time

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A force generated by skeletal muscle that is spread throughout the connective tissue (fascia) is called a ________.

Epimuscular pathway

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Unused muscle is degraded or muscle protein degraded faster than it is replaced are two ways that ________ can occur.

Muscular atrophy

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When can you treat a somatic dysfunction?

Indication for OMMIndependent of other diagnosesDocumentableTrack improvement over timeBillable

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Soft-tissue and myofascial release are both ________ techniques.

Direct

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The capability of a solid to continually yield under stress with a measurable rate of deformation is known as ________ (as a property of fascia).

Viscosity

What are characteristics of superficial fascia?

Attached to skin Dense at the scalp, back of neck, and palms of hands and feet Loose everywhere else Holds the vast majority of interstitial fluid

What is a cybernetic loop?

An unconscious reaction by the patient followed by a similar unconscious reaction by the physician

An ________ is the limit of passive motion (bony endpoint).

Anatomical barrier

A ________ is the limit of active motion and is ________ of being altered.

Physiological barrier, capable

Where was fascia first officially defined?

First International Fascia Research Congress

Lots of mitochondria, smaller, smaller nerves, extensive blood supply, and large supplies of myoglobin (red) are all characteristics of ________ type muscle fibers.

Slow

What is the term for "pigeon breast"?

Pectus carinatum

What is a spinal dysraphism?

An incomplete fusion or malformation of bone and neural structures of the spine region

Continued deformation of a visco-elastic material under constant load over time is also known as ________.

Creep

Fewer mitochondria, larger, extensive sarcoplasmic reticulum, minimal blood supply, less myoglobin (white), and glycolytic enzymes present are all characteristics of ________ type muscle fibers.

Fast

Detection of a mechanical problem, locating a problem, and measuring improvement are all reasons for why we perform ________. It is the most objective assessment tool for categorizing somatic dysfunction.

Motion testing

How much energy from nutrients gets used to make ATP and how much of nutrients can be converted to Work, under optimal conditions?

50% and 25%

A ________ is all muscle fibers that are innervated by a single neuron.

Motor unit

How can hypertrophy be described in muscle?

Existing muscle fibers gain more actin and myosin. New muscle fibers are not created

When is phosphocreatine used and for how long?

At the beginning of contraction (maximal) for approximately 5-8 seconds

What are I bands and how do they appear under a light microscope?

Regions composed entirely of actin and appear white

Why was touch "lost" in patient-physician interactions during the dark ages?

Physicians avoided touching patients due to the plague

What is the "ideal structure" of the human body?

Symmetry in all three planes

The normal thoracic spine ROM degrees are ________ (T1-T4), ________ (T5-T8), and ________ (T9-T12) for lateral flexion and ________ (T9-T12) for rotation.

5-25, 10-30, 20-40, 30-45

What does troponin inhibit and what prevents troponin from doing so?

Cross-bridging and Ca++ (troponin has a high affinity for Ca++)

What are the two types of contractions and their respective subdivisions?

Isometric: contraction where muscle does not change length Isotonic: - eccentric: contraction where muscle gets longer - concentric: contraction where muscle gets shorter

Name the different types of mechanoreceptors.

Pacinian corpuscles, Meissner's corpuscles, Ruffini corpuscles, Merkel's discs

How much of the ECM is water?

90%

For multistage exams for somatic dysfunction, what should you do and in what order?

Screening - general impression (whole body)Scanning - scan regions identified by screening (ex. thoracic region)Local examination - specific tissue characteristics

Stress applied to a body is proportional to the strain produced as long as the limit of elasticity is not exceeded. This is known as ________ law.

Hooke’s

Which vertebral level does the spine of the scapula approximate?

T3 (spinous process and transverse process)

Where are the transition zones?

OccipitoatlantalCervicothoracicThoracolumbarLumbosacral

What metabolic pathway supplies 95% of sustained contraction?

Oxidative phosphorylation

________ can be defined as all the collagenous-based soft-tissues in the body, including the cells that create and maintain that network of extra-cellular matrix.

Fascia

When do "cross-overs" occur? Where does this typically occur?

Whenever the postural line crosses the gravitational line. At transition zones

The perceived quality of motion as an anatomical/physiologic restrictive barrier is approached is known as ________.

End-feel

What is the smallest size the fingers are able to discriminate?

1-2mm

________ involves the way a system is held together by its connecting elements to create/maintain balance between stability and strength.

Tensegrity

Somatic dysfunction is named for it’s ________.

Ease

There are ________ contraindications to myofascial release techniques.

When do we stop making elastin?

Around 12-13

How was fascia described in the past?

Something that separated one organ from another, something that was dissected through, or something that was discarded,

What is the term for "knock-kneed"?

Genu valgus

What is hyperextension of the knee called?

Genu recurvatum

What are the objective diagnostic findings of somatic dysfunction?

TART:Tissue texture changeAsymmetryRestricted Range of MotionTenderness

What are the causes of Cushing's Disease/Syndrome? What are some signs and symptoms?

Excessive amounts of cortisol for a long period of time (either due to corticosteroid medication or endogenous overproduction)Hypertension, diabetes, osteoporosis, moon face, buffalo hump, depression, mood swings

________ motor muscles have motor units consisting of a few muscle fibers whereas ________ motor muscles have motor units consisting of many muscle fibers.

Fine, gross

How is fascia related to each of the models of osteopathic care?

Structural: plays a role in Dx and TxRespiratory-Circulatory: may act as a barrier to circulation, respiration pulls all fascia Neurologic: reflects physiological stateBehavioral: myofascial reflection of inner emotion Metabolic: directs forces, metabolic activity takes place in fascia

Define somatic dysfunction.

Impaired or altered function of related components of the somatic system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements

A ________ is a form of a restrictive barrier in which permanent restriction of joint motion is associated with a pathological change in tissues.

Pathological barrier

Medial and lateral winging of the scapula are caused by damage to what muscles/nerves?

Medial winging: serratus anterior - long thoracic nerveLateral winging: rhomboids and trapezius - dorsal scapular and spinal accessory nerves

What links Z disks with myosin filaments?

Titin

What is believed to attach tropomyosin to actin?

Troponin

What vertebral level does the iliac crest approximate?

L4 (spinous process) - malesL5 (spinous process) - females

What vertebral level does the nipple line approximate?

What is the definition of palpation?

Diagnostic and therapeutic "touch" as combined with OMT

What are A bands and how do they appear under a light microscope?

Composed of myosin filaments, either alone or overlapping with I bands. They appear dark

What are Z disks and what is the region between 2 Z disks called?

The anchoring site of actin. Sarcomere

In relation to the interconnectedness of fascia, what happens when your inhale/exhale?

Inhale: spinal curves straighten, extremities externally rotateExhale: spinal curves are exaggerated, extremities internally rotate

________ is a sense of resistance to light traction applied to the skin.

Skin drag

Where do mechanoreceptors orient themselves?

Along fascial architecture

How does each head of myosin act when "walking" across the actin?

Independently

What vertebral level does the inferior angle of the scapula approximate?

T7 (spinous process), T8 (transverse process)

What are the 3 types of motion used in OMM?

Active, passive, inherent Sub-classification of active/passive: regional, intersegmental

What are the five fascial functions?

PackagingPassagewaysProtectionPowerProprioception/Nociception

What is special about the hip drop test?

It is a passive test that utilizes active motion

What does fascia need to function properly?

Water

What is the term for foot pronation?

Pes planus

What does inelastic fascia assist with and where is it found?

Increased pressure within a compartment to aid in blood and lymph circulation. Anterior compartment of the crus

What are the characteristics of a chronic somatic dysfunction?

Pain: dull, achy, itching, crawling, gnawing, burning Vasculature: vasoconstriction due to hypersympathetic tone Skin: cool, pale due to chronic increase sympathetic vascular tone Tissues: chronic congestion, stringy, ropy, fibrotic, contracture, thickened Musculature: hypotonic, mushy, limited range of motion due to contracture Viscera: somatovisceral effects common

What is the term for "funnel chest"?

Pectus excavatum

The normal cervical spine ROM degrees are ________ for flexion/extension, ________ for lateral flexion, and ________ for rotation.

45-90, 30-45, 70-90

What is the term for foot supination?

Pes cavus

With active and passive motion testing, in what order should you test the patient?

Active and then passive

How many myofibrils is each muscle fiber composed of?

Hundreds to thousands (approximately 1500 myosin filaments and 3000 actin filaments)

A relative palpable freedom of motion of an articulation or tissue is known as ________.

Ease

What does TART stand for?

Tissue texture changes, asymmetry, restricted range of motion, tenderness

What are the three classes of molecules contained within the ECM?

Structural proteins (collagen and elastins)ProteoglycansAdhesive glycoproteins (fibronectins and laminins)

In what order should you proceed with an examination regarding OMT?

Static structural examRegional range of motionLayer-by-layer palpationInter-segmental motion testing

What are the four types of mechanoreceptors?

Meissner's corpuscle, Pacinian corpuscle, Ruffini corpuscle, Merkel disks

The normal lumbar spine ROM degrees are _________ for flexion, ________ for extension, and ________ for lateral flexion.

70-90, 30-45, 20-35

A ________ is a normal physiological mechanism via an action potential and Ca++ release, whereas a ________ is tightening due to collagenous bands laid down by fibroblasts.

Contraction, contracture

The range between the physiological barrier and anatomical barrier is known as an ________. This is where ________ occurs before tissue disruption.

Elastic barrier, passive ligamentous stretching

What order should be followed for layer-by-layer palpation?

``` Observation Temperature Skin (scarcely touching) Fascia (no blanching of fingernails) Muscle (some blanching) Bone, tendon, ligament (complete blanching) Erythema friction rub ```

What anaerobic method of ATP production can be used to supply muscle? How long does it last?

Glycolysis. Approximately 1 min

What is required for Ca++ to be pumped back into the sarcoplasmic reticulum?

ATP